Casualty Assessment

Overview

Approach

  • safety
  • incident history - a medical call or a trauma?
  • introduce yourself
  • warn the patient to be still
  • assess the patient's level of consciousness

Primary Assessment

This is the stage where you find and treat specific life-threatening conditions in a specific order.

  1. CERVICAL SPINE - Provide support if you suspect a possible trauma.
  2. AIRWAY - Use manual techniques to open the airway in an unconscious patient
  3. BREATHING - Is the patient breathing? Is assistance required?
  4. CIRCULATION - Can you find a pulse? Are chest compressions necessary?
  5. BLEEDING/WET CHECK - Is there signifigant blood loss taking place?
  6. BLANKET AND OXYGEN - Administer as required.

CHIEF COMPLAINT/VITAL SIGNS

Continue by taking vital signs. Assess and treat the Chief Complaint. Gather information for the Health Call Report.

SECONDARY ASSESSMENT

A head to toe pysical assessment by visual inspection and palpation. Throughout the secondary assessment you must monitor all vital functions.

TRANSPORT

Once ambulance personnel arrive they will assume authority for the patient. You should make a complete report to them of the patient's condition and of all treatments you have given. Give them a copy of your Health Call Report.

APPROACH

Safety

You must be aware of any dangers to the patient, bystanders or yourselves. If there are endangering circumstances you must either remove the patient to a safe area or remove the hazard. **PUT ON YOUR LATEX GLOVES**

Incident History

Determine what has taken place. Is this a medical emergency or has the patient suffered a trauma? If the patient has possibly suffered a trauma to the cervical spine, provide support A.S.A.P.

Introduce Yourself

Introduce yourself as a firefighter while moving toward the patient. This helps to alleviate anxiety and establishes your authority. you may also learn something about the patient's level of consciousness by his reaction to you.

Warn The Patient To Be Still

Warn the patient to be still (not to move his head if a trauma to the head/spine may have occurred) and calm. The patient will be more responsive to calm and professional approach.

Level Of Consciousness

You must now determine the patient's general level of consciousness (A.V.P.U.). While approaching the patient, talk to him loudly and clearly to determine if there is any response to verbal stimulus. If the patient does not respond to your voice, quickly check for any response to painful stimulus by pinching the earlobe and/or rubbing the sternum with your knuckles (preferred).

    A - Alert. Is the patient alert?
    V - Verbal. Does the patient respond to questions?
    P - Painful. Does the patient respond to painful stimulus?
    U - Unresponsive. Is the patient completely unresponsive?

PRIMARY ASSESSMENT

Assess and treat the following priorities in order. Do not skip any priority.

Cervical Spine.

If the patient has suffered a trauma which may have injured the cervical spine you must provide support MANUALLY (using knees and hands) while you continue with the primary assessment. Do not move the patient or allow the patient to move on his own without providing support. Do not move a patient with a suspected spinal injury in order to treat or assess conditions not covered by the primary assessment or to take vital signs. If you MUST move a patient to assess or treat the ABCs, first bring the head to an anatomically neutral position while applying slight traction. Make sure the patient's body is immobile while this is being done. Once the head is in the neutral position, carefully move the patient to a stable position. A rigid collar should now be applied A.S.A.P. providing this does not signifigantly delay assessing the ABCs. MANUAL SUPPORT MUST BE MAINTAINED AT ALL TIMES.

Airway.

Is the airway patent (open)? Does the patient need to be repositioned or suctioned? If the patient is unresponsive, use the Modified Jaw Thrust (trauma incident) or Head Tilt - Chin Lift (medical) to ensure an open airway in order to assess whether the patient is breathing. If the patient is unresponsive and is positioned so that the tongue may possibly obstruct the airway, insert a mechanical airway.

Breathing.

Is the patient breathing on his own? If the patient is not breathing give two ventilations then check the pulse.

Circulation

Can you find a carotid pulse? Are chest compressions necessary?

Bleeding\Wet Check

Do a quick thorough head to toe physical and visual examination to determine if there is any bleeding taking place that would be considered life-threatening.

Blanket And Oxygen

Administer oxygen if there are any indications of respiratory distress, head injury or shock. Indications of respiratory distress include gasping, wheezing, HYPOventilation, HYPERventilation, flaring of the nostrils, cyanosis, pallor, chest pain, jugular vein distention, tracheal deviation and paradoxical movement upon breathing.

You have now completed the examination for life-threatening problems. Cover the patient if you think it is appropriate.

Priorities may be treated concurrently if necessary. For example, an arterial bleed could be treated while breathing is being assessed but breathing assessment should not be delayed more than momentarily.

It must be remembered that you may never get past the primary assessment in some patients. A common example would be a V.S.A. patient. However, if you do get past the primary assessment you must remember to continually monitor the ABCs and the patient's level of consciousness.

CHIEF COMPLAINT/VITAL SIGNS

Now is a good time to get a set of vital signs. While the vital signs are being taken, begin investigating the cause of the Chief Complaint (the main thing that is wrong with the patient). Provide treatment if possible.

If the patient is conscious:

Ask the patient what is bothering him if you haven't already. He may be able to tell you the exact nature of of his problem. If pain is his Chief Complaint, try to learn more by asking him to describe it as fully as possible. PQRST can be used to help you focus on the cause of the pain.

    P - Provoked. How did the pain start?
    Q - Quality. What does the pain feel like? (eg. sharp stabbing?,dull ache? etc.)
    R - Region. Where is the pain located?
    S - Severity. How bad does it hurt?
    T - Time. When did the pain begin? Does it come and go? How frequently?
If the patient is unresponsive:

Always check for a Medic Alert bracelet. Bystanders and/or family may be able to help you discover the cause of the unconsciousness. Common causes of unconsciousness are listed below.

    A - allergies or alcohol
    E - epilepsy
    I - insulin
    O - overdose
    U - uremia
    T - trauma
    I - infection
    P - psychiatric reasons
    S - stroke or syncopy
For all patients, try to obtain answers to the questions contained in AMPLE. Record the information on the Health Call Report.

    A - Allergies. Does the patient have any allergies to medications?
    M - Medications. Is the patient taking any medications? If so, what are they? Wher does he keep them? Has he taken any recently? When and how many? Where they effective?
    P - Past Medical History. Does the patient have any history of medical problems that may be relevent to the current problem?
    L - Last Ate. When did he last eat?
    E - Event. How did the current problem develop?
As long as you maintain the ABCs and monitor the patient's level of consciousness it is not crucial that you discover the cause of the Chief Complaint.

SECONDARY ASSESSMENT

For non-trauma patients the secondary assessment is of lesser importance and not normally done.

For trauma patients, begin a systematic examination for further injuries. Serious injuries to the head, neck, spine, chest, abdomen, pelvis or femurs are potentially life-threatening and transportation to the hospital A.S.A.P. is of primary importance. Immobilize any suspected fractures and dress wounds if time permits.

The usual sequence is as follows:

NECK - Do not move the patient if you have any reason to suspect that a cervical injury may have occurred. If a rigid collar has not been applied, GENTLY feel the cervical spine looking for bumps, gaps, hot spots or deformities. Look for Jugular Vein Distention or Tracheal Deviation.

SKULL - Palpate the skull from front to back. Look for bleeding, bumps, bruises, depressions or patient reaction to pain.

EYES - Check for lacerations, foreign objects, pupillary size, equality and reaction to light. If the patient is conscious, check for normalacy of vision. Look for bruising around the eyes. (racoon eyes) This is an indication of a possible skull fracture.

EARS - Check for fluid discharge, lacerations, lumps or bumps. Also check for bruising behind the ears. (battle signs) This is also an indication of a possible skull fracture.

NOSE - Check for lacerations, fluid discharge, patency, bruising or flaring of the nostrils. (an indication of respiratory distress)

MOUTH - Check for airway patency, (eg. vomitus, food, dentures, blood) swelling, bruising, lacerations, pain on biting, alignment of the jaw and odors.

FACE - Check for lacerations, bruising, deformity color and temperature.

SPINE - GENTLY feel the remainder of the spine looking for bumps, gaps, hot spots or deformities. DO NOT MOVE THE PATIENT TO CARRY OUT THIS ASSESSMENT.

CHEST - Check for symmetry, lacerations, bruising deformities and puncture wounds. (if you find an entry wound, look for an exit wound) Palpate for pain or deformities of clavicles or scapula. Check for pain on compression of the sternum and rib cage. Watch for paradoxical movement upon breathing.

ABDOMEN - Check for lacerations and bruising. Palpate all four quadrants of the abdomen. Look for hot spots, tenderness, distention, rebound pain or guarding.

PELVIS - Check for lacerations, bruising, deformities and tenderness. Check for pain on GENTLY stressing the pelvic girdle. Listen and feel for crepitus.

EXTREMITIES - Check for deformities, pain, swelling, lacerations, bruising, needle marks, bites, cyanosis, impairment of sensation, movement and strength. Compare left and right sides.

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